| Remittance Advice Overview – Professional | 2637 · Commercial · NH | — | Original policy ↗ |
| Remote Devices for Intermittent Monitoring of Intraocular Pressure | DME.00050 · Commercial | 1 | Original policy ↗ |
| Resident Services | CRHPAP - 002 · Effective Feb 14, 2019 · Commercial · IN, KY, MO, OH, WI | — | Original policy ↗ |
| Respiratory Viral Panel Testing in the Outpatient Setting | CG-LAB-14 · Commercial | 10 | Original policy ↗ |
| Review of Services for Benefit Determinations in the Absence of a Company Applicable Medical Policy or Clinical Utilization Management (UM) Guideline | ADMIN.00006 · Commercial | — | Original policy ↗ |
| Robotic Arm Assistive Devices | DME.00044 · Commercial | 1 | Original policy ↗ |
| Room & Board - Included Charges | Commercial · NH | — | Original policy ↗ |
| Roster Automation Rules of Engagement | CABC-CDCRCM-26116-23-CPN25245 · Commercial, Medicaid · CA | — | Original policy ↗ |
| Roster Automation Rules of Engagement | MULTI-BCBS-CRCM-26126-23-CPN25245 · Commercial · CO, CT, GA, NH, OH, VA | — | Original policy ↗ |
| Roster Automation Rules of Engagement | Commercial · IN | — | Original policy ↗ |
| Roster Automation Rules of Engagement | Commercial · KY | — | Original policy ↗ |
| Roster Automation Rules of Engagement | Commercial · ME | — | Original policy ↗ |
| Roster Automation Rules of Engagement | MOHB-CDCR-26133-23-CPN25245 · Medicaid · MO | — | Original policy ↗ |
| Roster Automation Rules of Engagement | WIBCBS-CDCRCM-26125-23-CPN25245 · Commercial, Medicaid · WI | — | Original policy ↗ |
| Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence | CG-SURG-95 · Commercial | 19 | Original policy ↗ |
| Sanctioned Providers | G-10002 · Effective Dec 30, 2024 · Medicaid · OH | — | Original policy ↗ |
| Sanctioned Providers | G-10002 · Effective Dec 30, 2024 · Medicaid · NV | — | Original policy ↗ |
| Screening Services with Related Evaluation and Management Services | C-12002 · Commercial · VA | 8 | Original policy ↗ |
| Screening Services with Related Evaluation and Management Services – Professional | C-12002 · Effective Jan 1, 2026 · Commercial · CA | 8 | Original policy ↗ |
| Seat Lift Mechanisms | CG-DME-25 · Commercial | 5 | Original policy ↗ |
| Selected Protein Biomarker Algorithmic Assays | LAB.00011 · Commercial | 9 | Original policy ↗ |
| Senate Bill 137 (Provider Directory) FAQs | Commercial, Medicaid · CA | — | Original policy ↗ |
| Serum Biomarker Tests for Risk of Preeclampsia | LAB.00040 · Commercial | 8 | Original policy ↗ |
| Services Incidental to Admission | Commercial · NH | — | Original policy ↗ |
| SHBP Medical Policies & Clinical Guidelines Precertification Code List | Effective Jan 1, 2022 · Commercial · GA | 2,220 | Original policy ↗ |
| SHBP Medicare Advantage Sample ID Cards – 2018 | GA | — | Original policy ↗ |
| SHBP Prior Authorization Code List | Commercial · GA | 1,299 | Original policy ↗ |
| SHBP Prior Authorization Requirements | Commercial · GA | — | Original policy ↗ |
| SHBP Prior Authorization Requirements | Commercial · GA | 2,569 | Original policy ↗ |
| SHBP Sample ID Cards – 2018 | Commercial · GA | — | Original policy ↗ |
| Site of Service Payment Differential | Effective Dec 6, 2006 · Medicaid · NV | — | Original policy ↗ |
| Situations when Clinical Information is required for Claims Submission | Commercial · CA | — | Original policy ↗ |
| Sleep Studies and Related Bundled Services and Supplies – Professional | C-09009 · Effective Mar 1, 2023 · Commercial · VA | 12 | Original policy ↗ |
| Sleep Studies and Related Bundled Services and Supplies – Professional | C-09009 · Effective Jan 1, 2026 · Commercial · CA | 12 | Original policy ↗ |
| Sleep Studies and Related Bundled Services and Supplies – Professional and Facility | C-09009 · Effective Nov 1, 2026 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | 12 | Original policy ↗ |
| Sleep Studies and Related Bundled Services and Supplies – Professional and Facility | C-09009 · Effective Jan 1, 2027 · Commercial · CA | 12 | Original policy ↗ |
| Small Bowel, Small Bowel/Liver and Multivisceral Transplantation | TRANS.00013 · Commercial | 17 | Original policy ↗ |
| SoloHealth Station | Commercial · CT, GA, NH, VA | — | Original policy ↗ |
| Specialty Pharmacy Exception Request Form | Commercial · CA | — | Original policy ↗ |
| Specialty Pharmacy Program Expansion - Level of Care Review FAQs | Commercial · CA | — | Original policy ↗ |
| Specialty Pharmacy Program Expansion - Level of Care Review FAQs | CG-DRUG-47 · Commercial · CT | — | Original policy ↗ |
| Specialty Pharmacy Program Expansion – Level of Care Review FAQs | Commercial · CO, NV | — | Original policy ↗ |
| Split Care Surgical Modifiers | G-11005 · Effective Aug 18, 2025 · Medicaid · IN | — | Original policy ↗ |
| Split Care Surgical Modifiers | G-11005 · Effective Aug 18, 2025 · Medicaid · NV | — | Original policy ↗ |
| Split Care Surgical Modifiers- Professional | C-23004 · Effective Dec 1, 2023 · Commercial · VA | — | Original policy ↗ |
| Split-Care Surgical Modifiers - Professional | C-23004 · Effective Jun 14, 2023 · Commercial · CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI | — | Original policy ↗ |
| Split-Care Surgical Modifiers - Professional | C-23004 · Effective Apr 1, 2026 · Commercial · CA | — | Original policy ↗ |
| SSBCI Clinical Criteria per CMS Requirements Form | ME | — | Original policy ↗ |
| Standard Local Prior Authorization Code List | Commercial · GA | 3,068 | Original policy ↗ |
| Standard precertification and prior authorization requirements | VABCBS-CM-067675-24 · Commercial · VA | — | Original policy ↗ |
